Abstract

Despite recent advances in antidepressant medication as the main treatment option for severe depression, large portion of patients are drug resistant. The side effects of the drugs sometimes occur before the treatment effects which can terminate the treatment process. Therefore, developing new efficient and safe alternative treatment is the main focus of scientific societies. The present study aimed to comparatively investigate the synergistic therapeutic effects of transcranial direct current stimulation (tDCS) and cranial electrical stimulation (CES) in major depression in a double blinded randomized controlled trial. This was a double blinded randomized controlled trial conducted on 30 major depression patients diagnosed by semi-structured review of DSMiv-TR by a psychologist. The patients filled the Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). The quantitative electroencephalograms of patients were recorded and analyzed with Neuroguide processing tool to determine the regions with abnormal function using the age and gender matched standard databases of quantitative electroencephalogram (QEEG0. Thirty patients were randomly divided into three groups: CES, combined CES-tDCS, and CES treatment. Each patient receive 6 sessions consisting of 3 consequtive days and 3 sessions on the every other day basis (3 sessions a week) of 20-min exposure. After the 6 treatment sessions the patients were asked to fill the BDI-II and BAI questionnaires. The combined treatment showed more response followed by CES and tDCS treatments (P<0.01). In addition, no significant difference was observed in the treatments' complications between the three groups (P>0.01). However, disease duration was significantly different between the three groups (P<0.01). Our findings showed that QEEG guided treatment with tDCS and CES can be effective in depression. It seems that tDCS acts through regulating the firing rate of cortical neurons and CEW through modulating the thalamus and limbic system in treatment of depression. Combined CES-tDCS can yield more efficient treatment.